title: Cerebrovascular correlates of sleep disorders-rational and protocol of a door-to-door survey in rural Coastal Ecuador.
abstract: BACKGROUND
  Little is known on the role of sleep disorders in the increased prevalence of cerebrovascular diseases in the developing world.
  
  
  OBJECTIVE
  The aim of this study is to assess the prevalence of major sleep disorders in a rural South American population and to determine whether these conditions are associated with stroke, ischemic heart disease, or with a poor cardiovascular health (CVH).
  
  
  METHODS
  Three-phase, population-based, door-to-door survey in Atahualpa. During phase I, all residents aged 40 years or older will be screened with validated Spanish versions of 5 questionnaires to evaluate major sleep disorders. In phase II, neurologists will examine persons suspected of having a sleep disorder and a random sample of negative individuals to assess the prevalence of these conditions and to validate the accuracy of questionnaires. In phase III, patients with a confirmed sleep disorder will undergo nocturnal polysomnography for achieving a more specific diagnosis. The occurrence of sleep disorders will be correlated with the CVH of the population and with the presence of stroke and ischemic heart disease.
  
  
  CONCLUSIONS
  This epidemiologic study may prove cost-effective in improving sleep conditions of people living in rural areas of developing countries and may be used as a model for the evaluation of sleep disorders and their cerebrovascular correlates in these populations.
authors.affiliation: School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador. Electronic address: oscardelbrutto@hotmail.com.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Del Brutto
authors.affiliation: Gastroenterology Department, Vanderbilt University, Nashville, Tennessee.
authors.forename: Robertino M
authors.initials: RM
authors.lastname: Mera
authors.affiliation: School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Farfán
authors.affiliation: Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, Florida.
authors.forename: Pablo R
authors.initials: PR
authors.lastname: Castillo
mesh_terms: D000328:Adult; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003906:Developing Countries; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D017286:Polysomnography; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
keywords: Ecuador; Stroke; cardiovascular health; ischemic heart disease; population-based study; sleep disorders